urethral stones
Introduction
Introduction to urethra stones Urinary calculi are rare in many cases, most of which originate from the urinary system above the bladder and bladder, such as kidney stones, ureteral stones or bladder stones. When the stone is discharged, it can stay in the urethra or invade the urethra, the scaphoid or the urethra of the prostate. A few are secondary to urethral stricture, urethral atresia, foreign body or urethral diverticulum. The stones that originate in the urethra are quite rare, usually single stones. Most of the stones in the combined infection are ammonium magnesium phosphate. Most female urethra stones occur in the urethral fistula. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: urethral stricture
Cause
Cause of urinary calculi
(1) Causes of the disease
Urethral calculi are divided into primary and secondary types, and the causes are as follows:
1. Primary urethral stones: refers to the stones that are formed in the urethra, urethral stricture, infection, retention cysts, mucosal damage, diverticulum and foreign bodies.
2. Secondary urethral calculi: refers to the formation of stones in the urinary system above the urethra and then into the urethra and stays in the urethra, staying in the urethral physiology and the proximal part of the stenosis, so the urethra stones are more common in the urethra Department, ball, penis, boat-shaped fossa and urethra.
(two) pathogenesis
Most of the urethra stones originate from the bladder and upper urinary tract, and stay in the prostatic urethra, urethral bulb, penis, scaphoid or urethral orifice, so its composition is consistent with the composition of bladder stones or upper urinary tract stones, if stones Related to infection, the primary urethral stones are mostly infected stones, usually multiple, stones can also be primary in the proximal urethral stricture or urethral diverticulum.
In addition to the damage of the primary disease, urethral stones can also cause urethral obstruction. The long-term mechanical stimulation of local mucosa caused by mucous membrane damage, inflammation, ulcer, hyperplasia, infection, abscess, etc., and even a few serious complications such as urinary fistula.
Prevention
Urethral stone prevention
Changing the urinary formation environment
According to the analysis, urinary calcium is the most common calcium oxalate, accounting for about 80%. In some areas, there are many urate stones. These stones are mostly formed in acidic urine environment, and calcium phosphate stones (about 9%) are in It is formed in an alkaline urine environment. Therefore, it is important to determine the nature of the stone according to the analysis of the stone composition, thereby consciously changing the acid-base environment of the urine, and is important for preventing the formation of stones and treating stone disease.
Pay attention to nutrition and diet
Don't eat too much, limit over-nutrition, because eating too much is a high-protein, high-sugar and high-fat diet, which will increase the risk of formation. Usually you should eat more whole grains and vegetarian food. If it is a stone patient, After the stone is cured, in order to prevent the recurrence of stones, patients with oxalate stones should avoid eating foods with higher oxalic acid, such as spinach, mushrooms, potatoes, chestnuts, black tea, coffee, chocolate, tomatoes, strawberries, persimmons, bayberry, etc. If you are a urate patient, you should pay attention to eating foods with high uric acid, such as animal visceral seafood, black tea, coffee, chocolate and peanuts. Patients with calcium phosphate stones should eat less calcium-containing foods, such as Milk and so on.
Drink more water
Develop drinking habits, drink more water can increase the amount of urine, dilute the crystals in the urine, making it easy to excrete, and even if the small stones have been formed, it can be washed out of the urine as soon as possible, some scholars pointed out that it is best Drink more than 2,500 ml per day to keep the urine color light. If the local water source contains high calcium, you should pay attention to softening before drinking. It is best to drink magnetized water.
Prevention and treatment of urinary tract infections
Urinary tract infection is a major local factor in the formation of uroliths, and is directly related to the prevention and treatment of urolithiasis. Urinary tract infections caused by Proteus, Staphylococcus and Streptococcus are most likely to induce stones, which can decompose urea into Ammonia makes the urine alkaline, so the urate is easy to precipitate and form stones. At the same time, the bacteria and the pus and the necrotic tissue can also form the core of the stone and slowly form stones.
Treatment of certain primary diseases that cause urinary calculi
For example, hyperparathyroidism (such as thyroid adenoma, adenocarcinoma or hyperplastic changes) can cause abnormal calcium and phosphorus metabolism and induce calcium phosphate stones. For this reason, patients should first treat parathyroid diseases.
Complication
Urethral calculi complications Complications urethral stricture
1, urethral obstruction:
Kidney and ureteral stones are most likely to be at the junction of the ureter and ureter, and the ureter stays across the iliac vessels and ureter, causing urethral obstruction. Lead to hydronephrosis, affecting kidney function, if not treated in time, it will seriously affect kidney function. If both sides of the urethra are obstructed, it will lead to uremia.
2, urinary tract infection:
Obstruction of urine caused by stones provides conditions for the growth of bacteria and can lead to urinary tract infections. The urinary tract infection is complicated by bacterial infection. The hydronephrosis can form renal empyema after the infection. Severe urinary tract infection may also cause septicemia. In addition, urinary tract infections promote the formation of stones, which rapidly increase the original stones.
3. Tumor:
Long-term stimulation of the urethra by stones can cause qualitative changes in the urethral epithelium, which can cause tumors, and hematuria can occur when there is a tumor.
4. Metabolic diseases:
Stones are made up of human metabolites. Different types of stones have different causes of metabolic abnormalities. Common gout, hyperuricemia, hyperparathyroidism, renal tubular acidosis, absorption of high oxalic acid and so on.
Stones stay in the urethra for a long time, can cause inflammation and stenosis of the urethra, and acute urinary retention. Severe cases can be complicated by abscess around the urethra, extravasation of the urine or urethral fistula.
Symptom
Symptoms of urethra stones common symptoms urethral thickening hard urinary tract stenosis urethral diffuse infiltration of urine flow is fluent male urinary tingling urinary tract obstruction urinary retention blood urinary urination foreign body urgency
1. Pain: Primary urethral stones are often gradually grown, or located in the sputum, early no pain symptoms, secondary stones are suddenly embedded in the urethra, often urinary tract pain and dysuria, pain can be penis Head, perineal or rectal radiation.
2. Difficulties in urination: stones cause urethral insufficiency, may have urinary line thinning, bifurcation and injection weakness, accompanied by frequent urination, urgency and urine drip, secondary urethral stones, due to sudden embedding of stones in the urethra, more sudden occurrence Urination was interrupted, and there was a strong sense of urinary tract and a sudden and severe urinary bladder. More acute urinary retention occurred.
3. Hematuria and urethral secretions: emergency patients often have terminal hematuria or urinary hematuria, or a little blood drops at the end of urination, accompanied by severe pain; chronic patients often have mucous or purulent secretions in the urethra.
4. Urethral tenderness and induration: Most patients can reach induration and tenderness in the urethra stones. The posterior urethra stones can be touched by the rectal examination. The multiple stones in the urethra can touch the sandstone of the stones. Friction.
Female urethra stones: Female urethra stones are less common than men, which is associated with short urethra and less bladder stones in women. Female urethra stones combined with urethral diverticulum, regardless of whether stones are combined or not, urethral diverticulum is often characterized by lower urinary tract infection, during sexual intercourse Pain is another prominent symptom. When the purulent secretions flow out, the symptoms will be temporarily relieved. The vaginal examination can touch the hard mass in the urethral area of the anterior wall. The treatment method is surgical removal of the urethral diverticulum and removal of stones. .
Examine
Examination of urethra stones
Laboratory inspection
Urine routine examination shows red blood cells, white blood cells and salt crystals, and may have pyuria when combined.
Film degree exam
1. X-ray examination: X-ray plain film can confirm urethral stones and their parts, and can check the upper urinary tract with or without stones, urethra can be found negative stones, with or without urethral stricture and urethral diverticulum.
2. B-ultrasound: The urinary tract stone image shows a strong echogenic light group in the urethral cavity with sound and shadow.
3. urethroscopic examination: urethra can directly observe stones, urethral complications and other abnormal conditions.
4. Urethral angiography: It is more clear the relationship between stones and urethra, especially for the diagnosis of stones in the urethra.
5. The posterior urethra stones can be touched by the rectal examination. The anterior urethra stones can be directly along the surface of the urethra. When the urethral probe is used for transurethral exploration, there may be friction sound and impact.
Diagnosis
Diagnosis and diagnosis of urethral calculi
diagnosis
Diagnosis of urethral stones In addition to careful medical history, physical examination is very important, mainly including the following:
1. Male anterior urethra stones can touch stones or induration and tenderness in the penis or perineum. The posterior urethra stones can be touched in the perineum or through the rectum. Stones in the scaphoid and urethra can even be seen. Female patients The vagina can touch the stones and the diverticulum.
2. Use a metal probe to inspect the urethra. When the probe touches the stone, it can feel hard and rubbing.
Differential diagnosis
When urinary calculi form acute urinary tract obstruction, the clinical manifestations are more typical, and the diagnosis is not difficult. Primary urinary calculi are often confused with certain diseases. The diseases that must be identified are:
Urethral stricture urethral stricture
The main symptoms are dysuria, weak urine flow, interruption or drip, and frequent urination, urgency, dysuria and urethral secretions in some infections. Some traumatic urethral strictures may also affect urethral induration.
Urethral stricture often has no history of renal colic and history of urinary sandstone, but has its primary cause, such as injury, inflammation or congenital, iatrogenic, etc., its dysuria is non-bursty, urethral exploration can be narrow The site was blocked, the X-ray plain film had no stone shadow, and the urethra angiography showed a narrow segment.
2. Non-specific urethritis
Non-specific urethritis, there may be dysuria, frequent urination, urgency and urethral secretions, chronic non-specific urethritis may be complicated by urethral stricture and dysuria.
Non-specific urethritis has no history of renal colic or urinary sandstone, no acute dysuria, urethral percussion can not touch the induration, X-ray examination without stone shadow.
3. Urethral injury
Urethral injury may have bleeding outside the urethra, pain in the urethra and dysuria, urinary retention, and urethral secretions when infected.
Urethral injury generally has a clear history of injury, often accompanied by extravasation of urine, local skin swelling, subcutaneous blood stasis, trial insertion of the catheter is not easy to insert into the bladder, and a few drops of blood can be drawn from the catheter, X-ray plain film can be seen pelvic fracture and other signs No stone shadows.
4. Urethral fistula
Due to urethral sphincter spasm, there may be symptoms such as urethral pain and dysuria, often caused by mental stress, local irritation and other factors.
Urethral tract without urinary sandstone history and urinary frequency urgency and other symptoms, can not sputum and urethral induration, urethra exploration can pass normally, X-ray examination without abnormalities, symptoms can be alleviated with sedatives.
5. Urethral foreign body
When foreign bodies in the urethra cause urinary tract obstruction, dysuria may occur, even urinary retention, foreign body irritation or secondary infection may have frequent urination, urgency, dysuria and hematuria.
However, the cause can be found, X-ray examination shows filling defects in the urethra, and foreign bodies can be seen by urethroscopic examination.
